Life-threatening triclopyr poisoning due to diethylene glycol monoethyl ether solvent

Abstract

Introduction

Triclopyr is a synthetic auxin-like herbicide. It is considered to have low toxicity and there are few reports of poisoning. We report two cases of life-threatening toxicity following ingestions of 250 mL of 50 g/L triclopyr co-formulated with diethylene glycol monoethyl ether (DEGEE).

Case reports

A 79-year-old male with a background of hypertension and atrial fibrillation presented two hours after ingestion with sedation, a severe high anion gap metabolic acidosis, raised osmolar gap and an aspiration pneumonitis. He was ventilated and dialysed for 10 h with resolution of the acidaemia. He was discharged home on day 33. A 66-year-old male with a past history of alcoholism and hypertension presented following a collapse. He had sedation, a severe high anion gap metabolic acidosis with a raised osmolar gap, acute kidney injury and vasodilatory shock. He was ventilated and received dialysis for 43 h. He had poor neurological recovery and died on day 10.

Discussion

Ingestion of triclopyr formulations can produce life-threatening toxicity. In large poisonings of triclopyr co-formulated with DEGEE, a high anion gap metabolic acidosis appears to be due to the glycol ether solvent rather than triclopyr itself. Management should focus on good supportive care including dialysis for significant metabolic acidosis.

Keywords:

• Triclopyr
• poisoning
• diethylene glycol monoethyl ether
• DEGEE

Acknowledgements

We thank Tomas Rosek for his assistance with the LCMS analyses.

Ethics approval

Informed consent was obtained in both cases for inclusion in the Australian TOxicology Monitoring (ATOM) Study. The ATOM Study has ethics approval from the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/14/QRCH/105).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work, and the body of work described therein, was supported by grants from the National Health and Medical Research Council of Australia (Grant Nos. 1055176, 1107356 and 1061041).